Outside the Beltway

NYC Health Officials Find New, Virulent HIV Strain

James Joyner · Friday, February 11, 2005 · 5 comments

NYC Health Officials Find New, Virulent HIV Strain (Bloomberg)

New York City doctors have discovered a previously unseen strain of HIV, which appears to be resistant to three of the four types of anti-viral drugs that combat the disease, and progresses from infection to full-blown AIDS in two or three months, the health department said. “We’ve identified this strain of HIV that is difficult or impossible to treat and which appears to progress rapidly to AIDS,” said New York City Health Commissioner Thomas Frieden. Frieden said the case, diagnosed in a man in his mid-40s who reported multiple male sex partners and unprotected anal sex — often while using the drug crystal methamphetamine — was “extremely concerning and a wake-up call.”

Antonio Urbina, medical director of HIV education and training at St. Vincent’s Catholic Medical Center, site one of Manhattan’s largest AIDS clinics, said at a news conference that the patient’s use of crystal methamphetamine shows that the drug “continues to play a significant role in facilitating the transmission of HIV.” The drug reduces peoples’ inhibitions and their likelihood of using condoms or other forms of safe sex, he said.

While drug resistance is increasingly common among patients who have been treated for HIV, cases of three-class antiretroviral-resistant HIV — or 3-DCR HIV — in newly diagnosed, previously untreated patients are extremely rare, and the combination of this pattern of drug resistance and rapid progression to AIDS may not have been seen previously, the Health Department said in a news release. The strain found in New York was “highly unusual,” said Ronald Valdiserri, 53, deputy director of the National Center for HIV, Sexually Transmitted Diseases and Tuberculosis at the U.S. Centers for Disease Control, in an interview. “We’re talking about a single case, but clearly the fact that we are dealing with such broad resistance of drugs and the rapid clinical progression is quite alarming,” Valdiserri said.

Frieden said the one drug the HIV strain isn’t resistant to is Enfuvirtide, sold under the trade name Fuzeon, developed by Trimeris Inc. of Durham, North Carolina, and Roche Holding AG of Switzerland. The drug, which costs a patient an average $20,000, is the first in a class called fusion inhibitors that work by preventing HIV from infecting healthy cells. It requires a 20-minute mixing process and twice-daily injections, according to the Fuzeon Web site. The problem, Frieden and other physicians said, is that this drug is most effective when used in a “cocktail” with other retrovirus drugs such as nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors.

NPR, from which I was tipped to the story, didn’t mention that the patient in question had “unprotected anal sex” with “multiple male sex partners,” often while “using the drug crystal methamphetamine.” Given that the public has been widely educated about the pitfalls of such behavior for over two decades now, one presumes it isn’t epidemic. Still, the discovery of a new strain of this deadly virus that’s resistant to the current treatment regime is bad news. Whatever one thinks of its explanation for the origin of the human species, there is no dispute that natural selection takes place among viruses.

Update (2-15): NYT/IHT picks up the story.

A previously unknown strain of HIV that is highly resistant to virtually all known drugs and appears to lead to the rapid onset of AIDS was detected in a man last week, New York health officials said Friday. […] [T]he resistance comes in combination with its rapid transformation into AIDS. Each of those things has been seen before, but never together.